The Safety of Immediate Shoulder Mobilization Following Pacemaker and Cardioverter Defibrillator Implantation

Purpose: The number of patients with cardiac implanted devices such as Cardioverter Defibrillators (ICD) and Pacemakers (PM) are steadily increasing. The implantation is associated with short and long term adverse events. Ipsilateral shoulder complications affecting quality of life are well-described. No guidelines referring to shoulder mobilization protocols exist. Our study aims to determine the safety of early shoulder mobilization after implantation, to further apply early physiotherapy protocols and reducing functional disability

Methods: 32 patients underwent cardiac device implantation. Mean age was 76.4 years, 40% women. A total of 35 ventricular electrodes and 32 atrial electrodes were implanted, followed by full passive range of motion (ROM) of the ipsilateral shoulder. Electrophysiologic measurements were obtained before and after manipulation. Fluoroscopic assessment excluded gross lead dislocations. Measurements were obtained again on POD 1.

Results: Electrophysiologic measurements including Pacing threshold, Impedance and Sensing of the RA and RV electrodes were obtained pre and post passive shoulder mobilization. Regarding atrial lead parameters we observed no statistically significant difference in threshold (p-value= 0.068/0.9), Impedance (p value=0.4) and Sensing (p value=0.5) before and after limb mobilization. Two atrial lead dislocations occurred on the day after intervention (2.99%) and required a second lead implant. As for the ventricular leads, impedance differed significantly one day after implantation (851 Ohm vs 779 Ohm, p value=<0.001). However, these changes remain in the normal reference range, without clinical significance, and may result from inherent variability and also different measuring devices used on both days.

Conclusions: In our study, we observed two atrial lead adverse consequences with no dislocations of ventricular leads after ipsilateral, passive, full range of motion shoulder activation. The same rate of atrial lead dislocations is reported in the literature. This preliminary data may provide evidence for early and safe passive shoulder activation following pacemaker and ICD implantation.